Renovascular Disease: Updated Management Protocols

Renovascular disease (RVD), including atherosclerotic renovascular disease (ARVD) and fibromuscular disease (FMD), significantly contributes to renal artery stenosis (RAS). ARVD, the predominant cause in Western populations, and FMD, more common in younger women, require distinct management approaches. Recent shifts in ARVD management focus on medical therapy rather than routine revascularization, driven by neutral outcomes from large randomized controlled trials (RCTs) like ASTRAL and CORAL. These studies highlight the limited benefit of revascularization for unselected patients, though high-risk individuals with severe hypertension or heart failure may still benefit. FMD management often includes revascularization, particularly effective for hypertension control. Current protocols emphasize comprehensive medical management for ARVD, utilizing antihypertensives, statins, and antiplatelet agents to mitigate cardiovascular risks. Identifying patients who benefit most from revascularization remains a priority, requiring a personalized, multidisciplinary approach. Future research aims to explore therapies targeting inflammation and fibrosis to enhance renal outcomes. Understanding patient-specific characteristics and employing targeted strategies are crucial for optimizing clinical outcomes in RVD management.